Risk factors for hyponatremia after administration of hypotonic fluids.

Abstract

BACKGROUND\nHypotonic maintenance intravenous fluids (IVFs) pose a higher risk of hyponatremia than isotonic maintenance IVFs. However, isotonic maintenance IVFs can result in excess sodium (Na) load in children. This study aimed to analyze the incidence and risk factors for hyponatremia in children who are administered hypotonic fluids with different Na concentrations and different maintenance rates.\n\n\nMETHODS\nWe performed a retrospective analysis using medical charts of children aged 3 months to 15 years. The children were normonatremic (Na ≥ 135 mmol/L and < 145 mmol/L) before IVFs, and administered IVFs containing 35 mmol/L Na at a 100% maintenance rate (Na 35) or fluids containing 84 mmol/L Na at a 70% maintenance rate (Na 84) for 24-48 h.\n\n\nRESULTS\nWe studied 463 children. Hyponatremia (Na < 135 mmol/L) occurred in 46/275 (17%) children who were administered Na 35 and 16/188 (9%) children administered Na 84 (P = 0.01). Multivariate logistic regression analysis showed that Na 35 (odds ratio [OR], 2.19; 95% confidence interval [CI], 1.04-4.62), low clinical dehydration scale (CDS) before IVFs (OR, 0.17; 95% CI, 0.06-0.49), and high body temperature 24-48 h after maintenance IVFs (OR, 2.39; CI, 1.79-3.18) were independent risk factors for hyponatremia.\n\n\nCONCLUSIONS\nMaintenance IVFs with low Na concentrations at a 100% maintenance rate, low CDS before IVFs, and a high body temperature 24-48 h after maintenance IVFs are independent risk factors for hyponatremia. This article is protected by copyright. All rights reserved.